Thank you for choosing us to care for your visual and health needs. Please call our office at (323) 521-4770 to schedule an appointment. If you are new to our office, please fill out the first four forms below. If you wear contact lenses, please also fill out the Contact Lens Questionnaire. If you are if you are seeing us for visual rehabilitation after a brain injury (such as stroke, car accident, aneurysm or brain tumor) please also fill out the Visual Rehabilitation Form.
A special “thank you” to Dr. Brisco and the staff who helped me in transitioning through a medical challenge. Knowing you are there for me gave me extra strength to continue my fight. God bless!
– Patricia A.
Filling out your forms ahead of time will help us to stay on schedule. Please fill out the forms below and either FAX them to our office before your appointment (323) 954-5807, email them to firstname.lastname@example.org, or bring them with you. Please note that there is a $35.00 Late Cancellation Fee for appointments that are changed or canceled within 24 hours of your appointment time. For Vision Therapy, a full session charge applies for missed appointments.
|Patient History||Download PDF|
|Contact Lens Questionnaire||Download PDF|
|Symptoms Checklist||Download PDF|
|Financial Policy||Download PDF|
|Visual Rehabilitation Form||Download PDF|
|Insurance Verification Form||Download PDF|